CausesCauses ofof sustosusto HispanicHispanic IdeologiesIdeologies ofof Diabetes:Diabetes: TheThe RoleRole ofof SustoSusto inin thethe U.S.U.S. oftenoften SustoSusto suffererssufferers CarinCarin K.K. Deines-WallaceDeines-Wallace includeinclude relationshiprelationship maymay bebe unableunable troubles,troubles, financialfinancial toto fulfillfulfill theirtheir Dr.Dr. DanielDaniel Benyshek,Benyshek, AAdvisordvisor difficulties,difficulties, oorr www.georgiabulletin.org/local/2002/04/18/bwww.georgiabulletin.org/local/2002/04/18/b Images.hispanicprwire.com/5716_1_lr.jpgImages.hispanicprwire.com/5716_1_lr.jpg socialsocial obligations.obligations. DepartmentDepartment ofof AnthropologyAnthropology & EthnicEthnic SStudiestudies witnessingwitnessing tragedy.tragedy.

FocusFocus GroupGroup RResultsesults AbstractAbstract (Interviews(Interviews Incomplete)Incomplete)

SustoSusto iiss anan illnessillness ooftenften rreferredeferred ttoo iinn HHispanicispanic ttradition.radition. OOftenften cconsideredonsidered a cclassiclassic WhileWhile thisthis pprojectroject iiss oonlynly hhalf-complete,alf-complete, rresultsesults ffromrom tthehe ffocusocus ggrouproup aarere a ggoodood exampleexample ofof a culture-boundculture-bound ssyndrome,yndrome, ssustousto iiss ffrequentlyrequently ddiscountediscounted iinn WWesternestern indicationindication ooff cconsensusonsensus aamongmong tthehe sstudytudy ppopulation.opulation. PParticipantsarticipants uunanimouslynanimously biomedicalbiomedical practice.practice. RRecentecent rresearchesearch hashas centeredcentered oonn ddiscoveringiscovering HHispanicispanic describeddescribed a causalcausal relationshiprelationship betweenbetween diabetesdiabetes andand sustosusto. A casecase ooff sustosusto isis mmoreore explanatoryexplanatory mmodelsodels fforor ddiseaseisease aandnd bbridgingridging tthehe ddivideivide bbetweenetween tthehe eexplanatoryxplanatory TheThe purposepurpose ofof thisthis projectproject isis toto qualitativelyqualitatively iinvestigatenvestigate tthehe rrelationshipelationship bbetweenetween effectiveeffective atat ccausingausing ddiabetes,iabetes, ttheyhey bbelieve,elieve, thanthan anyany bbiomedicaliomedical causalcausal ffactoractor (such(such asas modelsmodels ofof HHispanicispanic ppatientsatients aandnd ttheirheir mmedicaledical ppractitioners.ractitioners. WWhilehile pprogressrogress iiss bbeingeing diabetesdiabetes aandnd ssustousto bbyy eelicitingliciting tthehe HHispanicispanic eexplanatoryxplanatory mmodelsodels ooff ddiabetesiabetes aandnd poorpoor dietdiet oorr llackack ooff eexercise.)xercise.) CCasesases ooff sustosusto werewere broughtbrought oonn bbyy ttraumaticraumatic ppersonalersonal mademade ttowardoward ssuccessfuluccessful nnegotiationsegotiations ooff eexplanatoryxplanatory mmodelsodels bbetweenetween ppatientsatients aandnd sustosusto fromfrom participantsparticipants andand investigatinginvestigating hhowow ttheyhey iintersect.ntersect. eventsevents wwhichhich sshockedhocked pparticipants’articipants’ ssystems,ystems, aaffectingffecting tthemhem ssoo ggreatlyreatly tthathat ttheyhey ffeltelt practitioners,practitioners, ssustousto mmayay hhaveave mmoreore ssignificanceignificance thanthan previouslypreviously rrealized.ealized. HHispanicispanic diabetesdiabetes wwasas a ddirectirect rresult.esult. patientspatients diagnoseddiagnosed withwith diabetesdiabetes oftenoften believebelieve thatthat a previousprevious casecase ofof sustosusto causedcaused theirtheir condition.condition. SuchSuch a commoncommon bbeliefelief mmayay uunderlienderlie a rrelationshipelationship ooff ddeepereeper ssignificance.ignificance. Additionally,Additionally, participantsparticipants iincludedncluded corajecoraje (anger)(anger) andand tristezatristeza (sadness)(sadness) asas causescauses ooff diabetes,diabetes, equallyequally capablecapable ooff causingcausing diabetesdiabetes asas sustosusto. StudyStudy pparticipantsarticipants aarere rrecruitedecruited ffromrom a ppopulationopulation ooff 330000 ppatientsatients uundernder ttreatmentreatment bbyy a locallocal nnon-profiton-profit ggrouproup pprovidingroviding ffreeree hhealthealth vvisitsisits aandnd mmedicationsedications ttoo HHispanicsispanics wwithith WhatWhat isis thethe rrelationshipelationship bbetweenetween ddiabetesiabetes aandnd sustosusto? ItIt isis expectedexpected (though(though notnot assumed)assumed) thatthat datadata derivedderived fromfrom one-on-oneone-on-one ethnographicethnographic diabetes.diabetes. PatientsPatients wishingwishing toto bebe involvedinvolved inin thethe studystudy participatedparticipated inin a focusfocus groupgroup andand interviewsinterviews ((expectedexpected ccompletionompletion JJuneune 22006)006) wwillill ssubstantiateubstantiate tthesehese rresults.esults. currentlycurrently ongoingongoing one-on-oneone-on-one eethnographicthnographic iinterviews.nterviews. SignificanceSignificance A rrelationshipelationship foundfound toto existexist bbetweenetween tthehe ttwowo iillnessesllnesses wwillill hhaveave iimplicationsmplications fforor biomedicine,biomedicine, forfor earlyearly ddiagnosisiagnosis aandnd ttreatmentreatment ooff ddiabetes,iabetes, iinn aadditionddition ttoo eeffectiveffective AnAn improvedimproved understandingunderstanding ofof ideologicalideological relationshipsrelationships betweenbetween sustosusto andand ddiabetesiabetes negotiationnegotiation ooff explanatoryexplanatory mmodelsodels iinn tthehe ttreatmentreatment ooff ssustousto aandnd vvalidationalidation tthereofhereof aass mmoreore amongamong HispanicHispanic AmericansAmericans inin LasLas VegasVegas maymay havehave importantimportant appliedapplied implications:implications: thanthan jjustust a “folk“folk iillness.”llness.” ExcerptsExcerpts fromfrom FocusFocus GroupGroup QQuestioninguestioning RRouteoute InIn clinicalclinical ssettings,ettings, itit mmayay meanmean earlierearlier diagnosisdiagnosis andand treatmenttreatment ofof diabetesdiabetes whenwhen (Conducted(Conducted MarchMarch 99,, 22006)006) HispanicHispanic patientspatients mentionmention casescases ofof sustosusto toto informedinformed biomedicalbiomedical practitioners.practitioners. Additionally,Additionally, thethe rresultsesults ooff tthishis sstudytudy mmayay lleadead ttoo tthehe eeffectiveffective nnegotiationegotiation ooff explanatoryexplanatory modelsmodels iinn tthehe ttreatmentreatment ooff sustosusto andand thethe validationvalidation ofof patientpatient complaints,complaints, WhatWhat isis SustoSusto? 1.1. HowHow longlong dodo youyou thinkthink yyouou hhadad ddiabetesiabetes bbeforeefore yyouou wwereere ddiagnosed?iagnosed? asas biomedicalbiomedical ppractitionersractitioners aarere eencouragedncouraged ttoo bbee iinformednformed aandnd rrespectfulespectful ooff illnessesillnesses thatthat areare notnot formallyformally recognizedrecognized inin biomedicine.biomedicine. ThereThere maymay bebe implicationsimplications ThereThere iiss nono singlesingle ddefinitionefinition ooff sustosusto. ForFor some,some, sustosusto refersrefers toto bothboth ccauseause aandnd eeffect.ffect. IInn 2.2. WhenWhen diddid youyou firstfirst feelfeel thethe ssymptomsymptoms ooff ddiabetes?iabetes? forfor PublicPublic HHealthealth iinn rregionsegions wwithith llargearge HHispanicispanic ppopulations.opulations. AAss llocalocal bbiomedicaliomedical thesethese cases,cases, tthehe iillnessllness ooff sustosusto maymay bebe thethe rresultesult ooff ssoul-lossoul-loss wwhilehile tthehe eexperiencexperience ooff a sustosusto, Prompt→DidPrompt→Did youyou feelfeel thethe ssymptomsymptoms ooff yyourour ddiabetesiabetes ttwowo yyearsears bbeforeefore yyouou wwereere ddiagnosed?iagnosed? practitionerspractitioners bbecomeecome betterbetter informedinformed aboutabout HispanicHispanic ideologiesideologies ofof disease,disease, manymany maymay oror fright,fright, mmayay iinn tturnurn ccauseause ssoul-lossoul-loss ((O’NellO’Nell 11975).975). SStilltill oothersthers mmayay tthinkhink ooff sustosusto asas a OrOr waswas itit afterafter thethe doctordoctor toldtold youyou thatthat youyou havehave diabetes?diabetes? WhenWhen diddid youyou startstart feelingfeeling badly?badly? realizerealize thatthat theirtheir oownwn EEMsMs andand thosethose ofof theirtheir patientspatients maymay differ.differ. CommunicationCommunication stressedstressed statestate ddueue ttoo a ffrightright oorr a ttraumaticraumatic eevent.vent. FForor HHispanicsispanics wwhoho hhaveave llivedived iinn tthehe betweenbetween patientpatient andand practitionerpractitioner isis crucialcrucial forfor thethe potentialpotential ofof economiceconomic andand humanhuman UnitedUnited StatesStates forfor somesome timetime oror areare secondsecond generationgeneration HispanicHispanic Americans,Americans, a casecase ofof sustosusto isis a 3.3. WhatWhat sortssorts ofof thingsthings hhaveave yyouou aallll hheardeard ddoctors,octors, nnursesurses aandnd ootherther ppeopleeople aatt tthehe ccliniclinic ssayay tthathat savingssavings ttoo bbecomeecome a rreality.eality. statestate ofof anxietyanxiety oorr sstresstress ccausedaused bbyy aann uupsetpset iinn ttheirheir llivesives ssuchuch aass rrelationshipelationship ttroubles,roubles, ffinancialinancial leadslead s tot o diabetes?diabetes? difficulties,difficulties, oorr wwitnessingitnessing ttragediesragedies ((Lumsden,Lumsden, PPersonalersonal CCommunication).ommunication). Prompt→WhatPrompt→What dodo theythey telltell youyou aboutabout thatthat causescauses diabetes?diabetes? ThingsThings youyou eat?eat? OrOr inheritinherit fromfrom youryour parents?parents? ReferencesReferences A sustosusto-causing-causing eventevent maymay occuroccur immediatelyimmediately priorprior to,to, oror twentytwenty yearsyears before,before, thethe a.a. A Arere ttherehere tthingshings bbesidesesides tthesehese tthathat ffamilyamily mmembers,embers, ffriendsriends aandnd ootherther ppeopleeople iinn tthehe onsetonset ofof symptoms.symptoms. IItsts ssymptomsymptoms aarere llossoss ooff aappetite,ppetite, nnervousness,ervousness, ssocialocial wwithdrawal,ithdrawal, communitycommunity saysay aboutabout whywhy peoplepeople hhaveave ddiabetes?iabetes? Andrews,Andrews, MMargaretargaret MM.. aandnd JJoyceenoyceen SS.. BBoyleoyle 19991999 TransculturalTranscultural CConceptsoncepts iinn NNursingursing CCare.are. PPhiladelphia:hiladelphia: LLippincottippincott WWilliamsilliams & WWilkins.ilkins. andand sleeplessnesssleeplessness ((AndrewsAndrews & BBoyleoyle 11999).999). IIff nnotot ttreated,reated, sustosusto isis sometimessometimes bbelievedelieved ttoo bbee Prompt→WhenPrompt→When youyou talktalk withwith oneone aanother,nother, ddoo yyouou eeverver ttalkalk aaboutbout aanythingnything eelselse tthathat yyouou tthinkhink Baer,Baer, RRobertaoberta DD.. aandnd MMartaarta BBustilloustillo potentiallypotentially ffatal.atal. A ffamilyamily mmemberember oror folkfolk healerhealer oftenoften treatstreats sustosusto usingusing magico-religiousmagico-religious mightmight causecause diabetes?diabetes? 19931993 SustoSusto andand MalMal ddee OOjojo aamongmong FFloridalorida FFarmworkers:armworkers: EEmicmic aandnd EEtictic PPerspectives.erspectives. techniquestechniques ((RubelRubel 11960)960) iinn wwhichhich tthehe ssouloul iiss rreturnedeturned ttoo tthehe bbody,ody, oorr tthroughhrough b.b. AreAre therethere tthingshings tthathat mmightight mmakeake ssomeone’someone’s ddiabetesiabetes wworseorse tthathat ddoctorsoctors aandnd nnursesurses MedicalMedical AAnthropologynthropology QQuarterly,uarterly, NNewew SSerieseries 77(1):90-100.(1):90-100. ethnopharmacologicalethnopharmacological ttechniquesechniques iinn wwhichhich sustosusto isis curedcured byby takingtaking iindigenousndigenous mmedicationsedications ddon’ton’t uusuallysually ttalkalk aabout?bout? Bolton,Bolton, RalphRalph (Trotter(Trotter 11982).982). A ccasease ooff sustosusto oftenoften rrequiresequires ssocialocial ssupportupport ffromrom ffriendsriends aandnd ffamily,amily, aass sustosusto Prompt→DoPrompt→Do youyou knowknow ofof anythinganything tthathat ccanan mmakeake yyourour ddiabetesiabetes wworse,orse, bbutut yyourour ddoctorsoctors ddon’ton’t ttalkalk 19811981 Susto,Susto, Hostility,Hostility, aandnd HHypoglycemia.ypoglycemia. EEthnologythnology 110:261-276.0:261-276. suffererssufferers maymay feelfeel overwhelmedoverwhelmed andand areare oftenoften unableunable toto fulfillfulfill theirtheir usualusual socialsocial obligationsobligations aboutabout it?it? Coronado,Coronado, GGlorialoria DD.. BBetieti TThompson,hompson, SSilviailvia Tejeda,Tejeda, RRubyuby GGodinaodina 20042004 AttitudesAttitudes andand BBeliefseliefs aamongmong MMexicanexican AAmericansmericans aaboutbout TTypeype 2 DDiabetes.iabetes. JJournalournal (Bolton(Bolton 11981).981). ofof HealthHealth CCareare fforor tthehe PPooroor aandnd UUnderservednderserved 115:576-588.5:576-588. 4.4. I Iff peoplepeople inin youryour ffamilyamily hhaveave ddiabetes,iabetes, iiss ttherehere mmoreore ooff a cchancehance tthathat yyou’llou’ll hhaveave iitt ttoo?oo? OOrr iiss iitt Hughes,Hughes, CCharlesharles CC.. moremore a mattermatter ofof chance?chance? 19851985 Culture-BoundCulture-Bound oror Construct-Bound?Construct-Bound? TThehe SSyndromesyndromes aandnd DDSM-III.SM-III. IIn:n: TThehe CCultureulture Prompt→CanPrompt→Can diabetesdiabetes runrun iinn ffamilies,amilies, oorr ccanan iitt hhappenappen ttoo aanyone?nyone? BoundBound Syndromes,Syndromes, RonaldRonald C.C. SSimonsimons andand CCharlesharles CC.. HHughes,ughes, EEds.,ds., 33-24.-24. LiteratureLiterature ReviewReview Jezewski,Jezewski, MMaryary AAnnnn aandnd JJaneane PPossoss 5.5. PleasePlease ttellell mmee mmoreore aaboutbout ssusto.usto. WWhathat iiss iit?t? 20022002 MexicanMexican AAmericans’mericans’ EExplanatoryxplanatory MModelodel ooff TTypeype 2 DDiabetes.iabetes. WWesternestern JJournalournal ooff StudiesStudies ofof sustosusto andand relatedrelated illnessesillnesses ttracerace bbackack ttoo tthehe mmid-twentiethid-twentieth ccentury.entury. SSinceince tthehe 6.6. WhatWhat hhappensappens ttoo yyouou wwhenhen yyouou hhaveave a sustosusto? PleasePlease givegive meme aann example.example. NursingNursing ResearchResearch 224(8):840-858.4(8):840-858. earlyearly 1980s,1980s, tthehe lliteratureiterature hhasas cconsideredonsidered tthesehese iillnessesllnesses ffromrom tthehe sstandpointtandpoint ooff Kleinman,Kleinman, AArthur,rthur, LeonLeon EisenbergEisenberg aandnd BByronyron GGoodood 7.7. AreAre therethere timestimes whenwhen youyou mightmight feelfeel uncomfortableuncomfortable talkingtalking aboutabout sustosusto? CanCan youyou 19801980 PatientsPatients andand HHealersealers iinn tthehe CContextontext ooff CCulture:ulture: AAnn EExplorationxploration ooff tthehe BBorderlandorderland socio-psychology,socio-psychology, physiology/biology,physiology/biology, psychiatry,psychiatry, andand fromfrom a holisticholistic pointpoint ooff vview.iew. talktalk aboutabout itit wwithith anyone?anyone? PreviousPrevious researchresearch oonn sustosusto hashas indicatedindicated tthehe causalcausal rroleole sustosusto playsplays inin thethe HispanicHispanic folkfolk betweenbetween AAnthropology,nthropology, MMedicine,edicine, aandnd PPsychiatry.sychiatry. BBerkeley:erkeley: UUniversityniversity ooff CCaliforniaalifornia PPress.ress. 8.8. A Arere therethere ppeopleeople whowho areare moremore llikelyikely ttoo ggetet sustosusto thanthan others?others? WWhy?hy? Lumsden,Lumsden, OlgaOlga modelmodel ofof diabetes,diabetes, asas wwellell aass ddescribedescribed sustosusto asas a culture-boundculture-bound syndrome,syndrome, oorr CCBSBS a.a. W Whoho ggetsets ddiabetesiabetes oorr hhighigh bbloodlood ssugarugar ddueue ttoo sustosusto? 20052005 PersonalPersonal CCommunication.ommunication. JuneJune 115,5, 22005.005. (Hughes(Hughes 11985;985; SimonsSimons 1985).1985). AAss a CCBS,BS, sustosusto wouldwould bebe anan illnessillness experiencedexperienced oonlynly Prompt→ArePrompt→Are ssomeome ppeopleeople mmoreore llikelyikely ttoo ggetet ddiabetesiabetes ffromrom sustosusto? O’Nell,O’Nell, CarlCarl WW.. byby HHispanics.ispanics. TThehe cculture-boundulture-bound ssyndromeyndrome cconceptoncept iiss a WWesternestern oone,ne, hhowever,owever, aandnd 19751975 AnAn InvestigationInvestigation ooff ReportedReported ““Fright”Fright” aass a FFactoractor iinn tthehe EEtiologytiology ooff SSusto,usto, ““MagicalMagical considerableconsiderable debatedebate eexistsxists aass ttoo iitsts uusefulnesssefulness ((KleinmanKleinman 11980).980). Fright.”Fright.” EthosEthos 3(1):41-63.3(1):41-63. Poss,Poss, JaneJane aandnd MMaryary AAnnnn JJezewskiezewski WhenWhen hearinghearing ofof theirtheir diabetesdiabetes diagnosis,diagnosis, manymany HispanicHispanic individualsindividuals areare ableable toto thinkthink 20022002 TheThe RoleRole aandnd MMeaningeaning ooff SSustousto iinn MMexicanexican AAmericans'mericans' EExplanatoryxplanatory MModelodel ooff TTypeype 2 Diabetes.Diabetes. MMedicaledical AAnthropologynthropology QQuarterlyuarterly 113:360-377.3:360-377. backback aandnd iidentifydentify a ppastast eexperiencexperience tthathat ccausedaused tthehe iillness.llness. TTheyhey maymay viewview sustosusto asas a Reimann,Reimann, JJoachimoachim OO.F.,.F., GGregoryregory AA.. TTalavera,alavera, MMichelleichelle SSalmon,almon, JJosephoseph AA.. NNunezunez aandnd RRobertooberto precipitatingprecipitating conditioncondition ccausingausing diabetesdiabetes ratherrather thanthan anan illnessillness inin itselfitself (Jezewski(Jezewski andand HispanicHispanic CausalCSocialSaoucsiall FactorsFSignificanceSaigctnoirfsic forfaonrc DiabetesDe iabetes J.J. Velasquez.Velasquez. PossPoss 2002:848).2002:848). TheseThese ideasideas aaboutbout iillnessllness aarere ppartart ooff ttheirheir eexplanatoryxplanatory mmodelsodels ((EMs),EMs), oorr tthehe SustoSusto TristezaTristeza ((Sadness)Sadness) 20042004 CulturalCultural CompetenceCompetence AAmongmong PPhysicianshysicians TTreatingreating MMexicanexican AAmericansmericans WWhoho HHaveave individualindividual beliefsbeliefs theythey holdhold aboutabout diabetesdiabetes andand sustosusto. RecentRecent researchresearch hashas ccenteredentered oonn Diabetes:Diabetes: A SStructuraltructural MModel.odel. SSocialocial SSciencecience aandnd MMedicineedicine 559:2195-2206.9:2195-2206. discoveringdiscovering HispanicHispanic explanatoryexplanatory mmodelsodels fforor ddiseaseisease ((JezewskiJezewski & PPossoss 22002;002; WWellereller eett Rubel,Rubel, ArthurArthur J.J. al.al. 1999)1999) aandnd bridgingbridging tthehe ddivideivide bbetweenetween tthehe eexplanatoryxplanatory mmodelsodels ooff HHispanicispanic ppatientsatients DietDiet 19601960 ConceptsConcepts ooff DDiseaseisease iinn MMexican-Americanexican-American CCulture.ulture. AAmericanmerican AAnthropologist,nthropologist, NNewew HeredityHeredity LackLack ofof EExercisexercise SeriesSeries 662:795-814.2:795-814. andand theirtheir medicalmedical practitionerspractitioners (Baer(Baer & BustilloBustillo 1993;1993; ReimannReimann etet al.al. 2004).2004). CorajeCoraje (Anger)(Anger) Simons,Simons, RonaldRonald C.C. 19851985 SortingSorting thethe Culture-BoundCulture-Bound Syndromes.Syndromes. In:In: TheThe Culture-BoundCulture-Bound Syndromes,Syndromes, RonaldRonald C.C. DiabetesDiabetes andand sustosusto appearappear ttoo overlapoverlap inin tthehe mmedicaledical aanthropologicalnthropological lliteratureiterature cconsistently.onsistently. SimonsSimons andand CharlesCharles CC.. HHughes,ughes, EEds.,ds., 225-38.5-38. ItIt isis possiblepossible thatthat thisthis overlapoverlap isis significantsignificant enoughenough thatthat itit hashas implicationsimplications forfor thethe diagnosisdiagnosis TrotterTrotter II,II, RobertRobert T.T. andand treatmenttreatment ofof diabetesdiabetes amongamong somesome HispanicsHispanics atat riskrisk forfor diabetes.diabetes. MedicalMedical anthropologicalanthropological 19821982 Susto:Susto: TheThe ContextContext ofof CommunityCommunity MorbidityMorbidity Patterns.Patterns. EthnologyEthnology 21:215-226.21:215-226. literatureliterature onon HispanicHispanic EEMsMs fforor ddiabetesiabetes cclearlylearly iillustratesllustrates tthishis iintersectionntersection ofof diabetesdiabetes andand Weller,Weller, SSusanusan CC.,., RRobertaoberta DD.. BBaer,aer, LLeeee MM.. PPachter,achter, RRobertobert TT.. TTrotter,rotter, MMarkark GGlazer,lazer, JJavieravier EE.. GarciaGarcia ddee AAlbalba GGarciaarcia aandnd RRobertobert EE.. KKlein.lein. sustosusto (Coronado(Coronado etet al.al. 2004;2004; PPossoss & JJezewskiezewski 22002;002; JJezewskiezewski & PPossoss 22002;002; WWellereller eett aal.l. 19991999 LatinoLatino BeliefsBeliefs AAboutbout DDiabetes.iabetes. DDiabetesiabetes CCareare 222(5):722-728.2(5):722-728. 1999).1999). IInn ddescriptionsescriptions ooff tthehe HHispanicispanic EEMM fforor ddiabetesiabetes iinn oonene llocationocation ((JezewskiJezewski & PPossoss 22002;002; WesternWestern BBiomedicaliomedical CCausalausal FFactorsactors fforor DDiabetesiabetes CoronadoCoronado eett al.al. 2004)2004) aandnd iinn rresearchesearch cconductedonducted iinn mmultipleultiple ssitesites tthousandshousands ooff mmilesiles aapartpart (Weller(Weller etet al.al. 1999),1999), diabetesdiabetes andand sustosusto areare ccausallyausally linkedlinked iinn HHispanicispanic eexplanatoryxplanatory mmodelsodels forfor diabetes.diabetes. ThisThis intersectionintersection bbetweenetween tthehe ttwowo iillnesses,llnesses, hhowever,owever, iiss fforor tthehe mmostost ppartart bbrieflyriefly HeredityHeredity DietDiet AcknowledgementsAcknowledgements mentionedmentioned andand hashas notnot bbeeneen cconsideredonsidered aass a rresearchesearch ttopicopic iinn iitself.tself. SustoSusto isis mentionedmentioned asas a ManyM any tthankshanks ttoo mmyy ccommittee:ommittee: DDr.r. DDanielaniel BBenyshek,enyshek, DDr.r. MMichelleichelle CChino,hino, DDr.r. TTonyony causecause ofof diabetesdiabetes fromfrom anan emicemic (insider)(insider) perspectiveperspective sufficientlysufficiently enoughenough thatthat furtherfurther BeingBeing OverweightOverweight IncreasingIncreasing AAgege Miranda,M iranda, aandnd DDr.r. JJohnohn SSwetnam,wetnam, ooff UUNLV;NLV; AAdditionally,dditionally, tthehe pprojectroject wwouldould nnotot hhaveave investigationinvestigation isis warranted.warranted. SuchSuch anan investigationinvestigation willwill betterbetter illustrateillustrate thethe apparentapparent connectionconnection LackLack ofof EExercisexercise beenbeen ppossibleossible wwithoutithout tthehe aassistancessistance ooff DDr.r. HHeidieidi SSwankwank ooff UUNLV,NLV, EmiliaEmilia GuenecheaGuenechea betweenbetween thethe twotwo illnessesillnesses andand maymay positivelypositively affectaffect patient/practitionerpatient/practitioner interactionsinteractions byby ofof thethe NevadaNevada CCancerancer IInstitute,nstitute, OOlgalga LLumsdenumsden ooff NNevadaevada AAlliancelliance AAgainstgainst DDiabetes,iabetes, increasingincreasing effectiveeffective communication.communication. MirnaMirna TroncosoTroncoso ooff UUNLV,NLV, andand JorgeJorge Sanchez.Sanchez.